med surg 1 Flashcards
1
Q
med srug
A
for hospitalized ADULTS with acute and chronic illnesses
PROMOTE HEALTH AND PREVENT ILLNESS
The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in clients from 18 to 100 years of age or older. The most common practice setting is the acute care hospital.
2
Q
RRT
A
rapid response team. used before respiratory or cardiact arrest occus. they are on site and available any time.
3
Q
self determination
A
Self-determination refers to the idea that clients are autonomous individuals capable of making informed decisions about their care. When the client is not capable of self-determination, the nurse is ethically obligated to protect the client as an advocate in the professional scope of practice.
4
Q
justice
A
equality
pt that has insure and not insured are treated the same
5
Q
benifacence
A
Beneficence emphasizes the importance of preventing harm and ensuring the client’s well-being.
6
Q
bedside computers
A
The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interdisciplinary care. Computers may be located at the client’s bedside or in the treatment room for ease of access.
7
Q
interdisciplinary (ID) plan of care for a client. Which health care team members are essential for the client’s daily care regimen
A
case meager
health care provider
8
Q
case menager
A
The case manager role includes coordination of acute care and post-discharge community services for the client
9
Q
iatrogenic error
A
error caused by medical treatemtn
10
Q
sentinal event
A
unexpected occurrence that causes serious harm or death to a patient
11
Q
AHRQ
A
best evidence based practive
12
Q
inpatient
A
pt admitted to the hospital
13
Q
outpatient/ambulatory
A
goes to the hospital the day of the surgery and returns the same day (same day surgery)
14
Q
diagnostic surgery
A
performed to determine cause of disorder or cancer (breast biopsy)
15
Q
curative surgery
A
performed to resolve health problem (appendectomy, cholysistectomy)
16
Q
restorative
A
performed to improve pt. functional ability (total knee replacement)
17
Q
palliative
A
performed to relieve symptms but not cure diesease (colostomy)
18
Q
urgent surgery
A
requires fast acting intervention
19
Q
emergent surgery
A
immediate intervention
20
Q
autologus donation
A
blood donation made by same patient just weeks beofre the surgery
21
Q
directed blood donation
A
pt’s family and friends may donate the blood
22
Q
smoking before surgery
A
smoking increases blood level of carboxyhemoglobin which decreases oxygen delivery to organs.
cilia decrease and there is retention of mucous secretions which predisposes the pt. to lung infection (pneumonia) and collapse of alvioli (atelectasis)
23
Q
postpone the surgery if
A
you find abnormal vitals signs. until problem is solved and vitals are stable postpone surgery and notify surgeon.
24
Q
morbidity
A
number of serious problems
25
mortality
number of deaths
26
hypokalemia
| hyerkalemia
hypokalemia- increases risk of toxticity, slows recovery from anesthesia, increases cardiact irritability
hyperkalemia- increases risk of dysrithmeas especially with use of anesthesia
correct any abnormal potassium levels before going to surgery
27
responsibility of nurse of consent sign
nurse is responsible to witness and verify the consent sign is signed
and
clarify what is taught by surgeon and dispel any myths
nurse must not provide detailed info about surgery. surgeon should
28
minimun amount of urine in one hour
30ml/ hours less than 20 call physitian
29
normal temp
97-100F
| anyting above or below call physitian
30
anesthesia provider
monitors pt. during surgery by assesing and monitoring levels of anesthesia, pulse ox, ABC, vital signs, i/o
31
nurse circulator
Circulating nurses or "circulators" are registered nurses who coordinate, oversee, and are involved in the client's nursing care in the operating room.
NOT SCRUBBED IN
sets up OR and ensures supplies are available. once the pt is ready to be moved to the OR the circulating nurse along with OR team transfer the pt into the operating bed. the nurse prositions the pt. and makes sure all bony areas are padded.
```
prepare room, get pt in OR
protects pt provacy and safety
ensures surgery team maintains sterile field
reports finding to surgeon
monitors trafic in the room
documents care
COUNT OF ALL SHARPS
```
32
scrub nurses
SCRUBBED IN
passes instruments to surgeon
set up sterile field
drape pt
-hand sterile equiptment to surgeon
Scrub nurses set up the sterile field, drape the client, and hand sterile supplies, sterile equipment, and instruments to the surgeon and the assistant.
33
specialty nurses
may be in charge of one particular type of surgery
34
endoscope
tube that allows viewing and manipulation of internal body area
35
minimaly invasive surgery
may inject gas into the cavity before the surgery to separate organs and improve visualization.
known as INSUFFLATION
36
anesthesia
1. general
2. local
3. regional
is to block nerve impulses transmission, suppress reflexes, relax muscles and in some cases achieve controlled levels of unconsciousness
37
general anesthesia- pt looses all funcitons, used when MUSCLE RELAXATION is needed
can given IV, inhilation, or balanced anesthesia
balanced anesthesia- combination of IV and inhalation
loos of conciousness induced by inhibiting neuronal impulses in CNS. DEPRESSES CNS and results in ANALGESIA and AMNESIA and UNCONCIOUSNESS.
stage 1- anelgesia & sedation, relaxation
stage 2- excitement, delerium
stage 3- operative anesthesia, surgical anesthesia
stage 4- danger
may cause respiratory problems, some pt may get regional to aviod respiratory problems
38
emergence
recovery from anesthesia
39
malignent hyperthermia
severe complication from general anesthesia. the reaction begins in skeletal muscle exposed to specific agents, causing increased calcium levels in muscle cells and increased muscle metabolism. serum calcium and potassium levels are increased as is the metabolic rate which leads to acidosis, cardiact dysrhythmias, and high body temp and MYOGLOBINURIA
EARLY INDICATION- is the presence of muscle proteins in the urine. rise in carbon dioxide levels and fall in oxygen levels. also sinus tachycardia
LATE INDICATION- extremely elevated temp as high as 111.2 F
DANTROLENE SODIUM, a skeletal muscle relaxent is the drug of choice for MH
The most sensitive indication of malignant hypothermia (MH) is an unexpected rise in the end-tidal carbon dioxide level, along with a decrease in oxygen saturation. Another early indication is sinus tachycardia. Survival depends on early diagnosis and the actions of the entire surgical team. Time is crucial when MH is diagnosed.
40
care of pt. with malignant hyperthermia
stop anesthesia
intubate patient and give 100% o2
terminate surgery
cooling techniques
41
overdose of anesthetic
can occur if pt. metabolism and drug administration is slower than usual. this is most likely to occur in OLDER pt and those with LIVER or KIDNEY problems
accurate info about pt. heigh weigh and medical history, liver and kidney functions are vital to determine anesthetic type and dosage
42
unrecognised hypoventilation
failure to exchange gases and can lead to cardicat arrest and permanent brain damage as well as death.
43
local anesthesia
```
delivered topically (applied to skin or mucous membranes)
or can be local infiltration - injected directly to the tissue around the insicion
```
pt. rempains conceous, gag reflex intact, no risk for aspiration
44
regional anesthesia
blocks multipe peripheral nerves in a specific body region.it may be used when general anesthesia cant be used because of medical problems.
pt. rempains conceous, gag reflex intact, no risk for aspiration
ex. nervle block, spinal block, epidural
45
concious sedation
IV delivery of hypnotic and opioid drugs to reduce level of conciousnes and allow pt to maintain airway and respond to verbal communication.
check ABS and VS frequently (
midaxolam (versed) most common benzodiapine for concious sedation, may be reersed with flumazenil (reverses respiratory deppression caused by versed)
propofol(diprivan)- sedative hypnotic, used in ambulatory settings, causes respiratory depression, NO ANTIDOTE
46
levels of concious sedation
```
0- fully awake
1- light sedation
2- moderate, slightly aware of sorroundings
3- deep sedation, unaware of sorrouding
4- general ansethesia, pt is unconcious
```
47
holding area nurse
Holding area nurses manage the client's care before surgery (shes not in the OR but in the holding room)
48
herbals
garlic, ginger, ginseng, ginkgo baloba- may cause excessive bleeding post op
st. johns wart- prolong effects of anesthesia
echinacea- may cause liver inflamation
49
elective surgery- planned ahead of time
emergent surgery- unexpected, urgent
50
liver- metabolized meds
kidneys- excrete meds
51
rating patients for anesthesia
```
p1- healthy pt.
p2- mild systemic disease
p3- severe systemic disease
p45- not expected to survive without surgery
p6- brain dead
```
52
propholactive antibiotics
60 min before urgery
53
muslum, arab, middle eastern
do not remove amulets they wear
no pork or alchohol
fast in the daytime during ramadan (do not take meds during ramasan)
knock before you enter
strong male dominance
nurses not seen as health care profestionals
pt. only told good news about their diesease
do not approve abortion
look down on people who are mentally ill
very modest
54
adjunct TO GENERAL ANESTHESIA
agent added to inhilation agent, such as opioids, benzodiapines,
55
opioids
anlegesia and sedation
respiratory depression
reversed with NALOXONE (NARCAN)
```
FENTANYL (SUBLIMAZE)
MORPHINE SULPHATE
SUFENTANIL(SUFENTA)
HYDROMORPHONE(DIALUDID)
MEPERIDINE (DEMEROL) NOT USED ANYMORE (Treats pain. This medicine is a narcotic pain reliever.)
```
56
BENZODIAPINES
PREMEDICATION FOR AMNESIA, INDUCTION OF ANESTHESIA AND FOR CONCIOUS SEDATION
midaxolam(versed)- most common benzodiapine, used in ambulatory surgery settings for CONCIOUS sedation
diazepam (valium)
lorazepam(ativan)
FLUMAZENIL9 romazicon) reverses benzodiapines
57
neuromuscular blocking agents
muslce relaxents
facilitate for intubation
OBSERVE AIRWAY CLOSELY
58
alergies
iodine or shellfish may indicate pt is alergic to products used to clean the surgical area
if alergic to banana, potatoe, apricot, kiwi pt may be alergic to latex also
59
Atropine
pre op medication given to dry up secretions and increase heart rate
Atropine-Helps keep your heart rate stable after a heart attack or during surgery. Lowers the amount of body fluids inside your mouth and throat before a surgery. This keeps you from possibly choking on your saliva while you are unconscious.
60
stages of anesthesia
induction phase: In the case of general anesthesia the anesthesiologist gives you the medications that make you lose consciousness,
maintenance phase: The anesthesiologist ensures that you remain anesthetized until the surgical, diagnostic or other treatment procedure is completed.
emergence phase: The anesthesiologist stops giving you the anesthesia medications, allows them to wear off, and/or gives you other medications to reverse their effects, so that you regain consciousness or sensation.
61
hydrostatic pressure- pumping of the heart, pushing fluid out of capilaries
water molecules in a confined space constantly press ourward against the confining walls
amount of water in any bofy fluid space determines pressure
62
filtration
movement of fluid through a membrane because pf the differences in hydrostatic pressure (equilibrium is reached when fluid leaves one space and enters the other space to make the hydrostatic pressure equal
63
edema
when changes in hydrostatic pressure occur such as in pt with CHF. heart is too weak to pump and blood backs up into venous system and venous hydrostatic pressure rises which causes capilary hydrostatic pressure to rise making it higher than that of the interstitial space. because of this excess filtration of fluid goes from capilaries to interstitial tissues causing edema
64
diffusion
free movemnt of particles accross a permable membrane from an area of high concentration to area of low concentration
it is importat for the transportation of electrolyes
65
some particles are impermeable
even though glucose is higher in ECF than in ICF it can not cross the membrane without the help of insuline. insuline makes the membrane more permeable to glucose
this is called facilitated diffusion
66
minimun urine output per day
40-600 ml
67
aldosterone
horomne secreted by adrenal cortext when sodium levels in ECF are decreased. it prevents water and sodium loss and acts on the nephrons of the kidneys to reabsorb sodium and water from the urine into the blood
68
ADH antidiuretic hormone
produced by the brain and acts on the kidney tubules making them more permeable to water as a result more water is reabsorbed and returened to the blood
69
pt with hypertension
are asked to lower their sodium intake because high sodium raises the blood level of sodium causing more water to be retained and blood volume to riose causing a higher blood pressure
70
ICF ECF
ICF fluid exists within the cell cytopalm and ECf outside the cell. one third of body volume is ECF and two thirds ICF
when urinating, vomiting, seating, you are loosing ECF fluid
71
renin angiotesin pathway
when kidneys sense a low parameter of water it secretes renin. renin This increases the volume of fluid in the body, which also increases blood pressure,
renin-angiotesin pathway is stimulated with shock or stress
pt. with hypertension often take ACE inhibitors
if you close angiotesin recepros blood pressure lowers
72
weight to fluid
1 L of water = 2.2 lb = 1 kg
weight change of 1lb = fluid volume change of about 500 mL
73
electrolytes
PSCCMP
74
antidiuretic hormone
from pituitary gland regulates osmotic pressure of extracellular fluid by regulating amount of water reabsorbed by kidneys
75
types of fluid volume deficits
isotonic dehydration- water and electrolytes lost in equal proportions
hypotonic dehydraton- electrolyte loss exceeds water oss
hypertonic dehydration- water loss exceeds electrolyte loss
76
types of fluid volume excess
isotonic overhydration- excessive fliod in ECF
hypertonic overhydration- rare, but may be caused by excessive sodium intake
hypotonic overhydration- known as water intoxication, excessive fluid moves into ICF and all body fluid compartaments expand
77
osmotic pressure
pressure from high to low concentration
78
oncotic pressure
pulling fluids from the surrounding tissue into the capillaries
79
sodium potasium pump
plays key role in maintaining volume of ICF
80
protein is responsible for
vascular and cell wall integrity
81
third space
fluid in spaces that arnt part of circulation such as asceites
iso-osmolar fluid shifts into body cavities wherefluid is not available for exchange with plasma volume
82
hyperonic saline
3% or 5% saline solution, rarely given only for hyponatermia, watch pt carefuly for seisures
83
major ICF electrolite
potassium
84
major ECF electrolyte
sodium
85
post op patient with small bowel resection is at risk for electrolyte imbalance because of
impaired exchange between anions and cations
86
cations (+)
sodium
potasium
calcium
magnesium
87
anions (-)
chloride
bicarbonate
phosphate
sulfate
88
hypotonic iv fluids
.45 % .33%
| and D5W
89
metabolic acidosis
hydrogen ions enter the cells and potassium moves to the ECF
90
hypocalcemia
trosseaus signs- hand curves in when taking bp
chovstek signs- when you tap on their cheek they blink
91
lasix (furosemide)
Treats fluid retention
| if you have hypercalcemia, you push lasic to get rid of fluid and get rid of the calcium
92
solute
substance dissolved in solution
93
solvent
liquid that contains a substance in solution
94
body fluid
solution that contains both electrolyes and water
95
electrolytes
substance that dissociates into ions when dissolved
96
high pH- alkeline
low pH- acid
97
max infusion rate of potassium chloride is
20mEq. hr
98
hypotonic
hypotonicity. in a hypotonic environment, fluid will enter a cell and cause it to swell and burst. the inside of the cell has higher osmotic pressure than the surrounding fluid, so fluid is drawn into the cell.
99
hypertonic
: the cell will shrink (crenation) by loss of its fluid to the surrounding hypertonic environment. high osmotic pressure of surrounding fluid pulls fluid out of the cell.
100
isotonic
if the concentrations of electrolytes are the same in the cell and surrounding fluid, the situation is balanced (homeostatic). the cell fluid volume remains the same.
101
expalin hypo iso hyper
½ ns iv is hypotonic relative to cells. fluid moves from the vascular space into the cells. when a liter of ½ ns is administered intravenously, it will go into the cells and very little will remain in the blood vessel (since it is hypotonic).
if you put two isotonic solutions side by side, no fluid shift occurs. a liter of normal saline or ringer’s lactate is limited to the extracellular space and will expand the blood volume.
5% dextrose in ns is hypertonic compared to cells; pulls water into the vascular space from the cells or interstitium.
102
only flush tubing with
normal 0.9% saline
103
fluid colume deficit
dehydration- body looses water and serum sodium levels increase
caused by scites, edema,
HYPOTENSION, rapid pulse
elevated BUN, serum osmolaroy, hemoglobin & hematocrit
water is hypotonic, if IV fluids are needed isotonic fluids are used
104
water fluid excess
water intoxication- state in which body retains water and sodium levels decrease
heart failure, renal failure, liver failure, indigenstion of table salt,
confusion, crackles, high bp, asltered conciousnes
decresed BUN, hemoglobin, hematocirt, urine osmolarity, and serum osmolarity
sodium restricted DIET
105
heparin
Heparin-Prevents clots in the blood vessels before or after surgery or during certain medical procedures. Also treats certain blood, heart, and lung disorders and helps diagnose and treat certain bleeding disorders. This medicine is a blood thinner.
106
heparin
Zantac-Treats and prevents heartburn with acid indigestion. Also treats stomach ulcers, gastroesophageal reflux disease (GERD), and conditions that cause your stomach to make too much acid (such as Zollinger-Ellison syndrome).
107
epinephrine
-Treats severe allergic reactions (including anaphylaxis) in an emergency situation.
108
Florinef (Fludrocortisone)-
s a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. the treatment of cerebral salt wasting.
109
diazipam (valium)
DIazapam (Valium)- Treats anxiety, muscle spasms, seizures, and other medical conditions. This medicine is a benzodiazepine.
110
acetaminophen (tylenol)
Acetaminophen (Tylenol)- Treats minor aches and pain and reduces fever.
111
calcitonin (fortical)
Calcitonin (Fortical)- Calcitonin is a 32-amino acid linear polypeptide hormone that is produced in humans primarily by the parafollicular cells of the thyroid, and in many other animals in the ultimobranchial body.
112
electrolyes
PRBC-Packed Red Blood Cells-bagged for blood transfusions.
0.9 % NSS-Normal Saline
D5W-5% dextrose in water- also contains normal saline.
Potassium chloride (KCl)- is a metal halide salt composed of potassium and chlorine.
Potassium phosphate (Neutra-Phos)- is a generic term for the salts of potassium and phosphate ions
Calcium gluconate- is the calcium salt of gluconic acid, an oxidation product of glucose, and contains 9.3% calcium
Sodium bicarbonate-sodium hydrogen carbonate is the chemical compound with the formula NaHCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda
Magnesium sulfate-Magnesium sulfate is an inorganic salt containing magnesium, sulfur and oxygen, with the formula MgSO4.
Phosphorus-Phosphorus is a nonmetallic chemical element with symbol P and atomic number 15. A multivalent pnictogen, phosphorus as a mineral is almost always present in its maximally oxidised state, as inorganic phosphate rocks.
113
reverses benzodiapines
Flumazenil (Romazicon)-
114
reverses opioids
Naloxone (Narcan)-
115
isotonic
same osmolality as ECF and normal plasma
- noosmotic pressure created so fluid remains in ECF
- used to replace ECF fluid and electrolyte loss and to expans vascular volume
0. 9 % and LR and 5% dextrose in water D5W
USED TO TREAT DEHYDRATION
116
hypotonic
lower osmolarity than normal plasma and ECF
- fluid moves from ECF to ICF, water pulled from vessles into cells causing increased cell volume and decreased vascular volume
- treats CELLULAR dehydration
- should not be used for people with fluid OVERLOAD
- should not be used for people with brain injuries because the brain is sensitive nd absorbs much water
-frequent monitoring of vitals, concousness, and cerculation
.45% 0.225%
117
hypertonic
higher osmolarity than normal plasma and ECF
- fluid moves from cells into vessels, resulting into increased vascular volume and decreases cell volume
(be careful to avoid celular dehydration)
(DONT USE WITH PT WITH FLUID VOLUME DEFICIT)
3% 5 % saline- used when sodium is low
10% dextrose-treats hypoglycemia
D5NS
